Left bundle branch pacing vs biventricular pacing in heart failure patients with left bundle branch block:A systematic review and meta-analysis

BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.

A METHOD IN SYSTEM DESIGN OF EJECTING DEVICES OF MISSILES

Anew method in system design of ejecting devices of missiles is first presented.Some important points are dis-cussed,which guid the research and development of new ejecting devices of missileg,amd provid the foundation flr thw design of mew ejecting device is provided.The system design includes the distribution of techmology specifica-tion,3-D solid modeling of ejecting devices of missiles im-ported from abroad,the design of pmeumatic device sys-tem,the design of ejecting mechanism system,the predic-tion of reliability and the experimental analysis,etc.

Heterogeneity in cardiorenal protection by Sodium glucose cotransporter 2 inhibitors in heart failure across the ejection fraction strata:Systematic review and meta-analysis

BACKGROUND Gliflozins or Sodium glucose cotransporter 2 inhibitors(SGLT2i)are relatively novel antidiabetic medications that have recently been shown to represent favorable effects on patients’cardiorenal outcomes.However,there is shortage of data on potential disparities in this therapeutic effect across different patient subpopulations.AIM To investigate differential effects of SGLT2i on the cardiorenal outcomes of heart failure patients across left ventricular ejection fraction(LVEF)levels.METHODS Literature was searched systematically for the large randomized double-blind controlled trials with long enough follow up periods reporting cardiovascular and renal outcomes in their patients regarding heart failure status and LVEF levels.Data were then meta-analyzed after stratification of the pooled data across the LVEF strata and New York Heart Associations(NYHA)classifications for heart failure using Stata software version 17.0.RESULTS The literature search returned 13 Large clinical trials and 13 post hoc analysis reports.Meta-analysis of the effects of gliflozins on the primary composite outcome showed no significant difference in efficacy across the heart failure subtypes,but higher efficacy were detected in patient groups at lower NYHA classifications(I2=46%,P=0.02).Meta-analyses across the LVEF stratums revealed that a baseline LVEF lower than 30%was associated with enhanced improvement in the primary composite outcome compared to patients with higher LVEF levels at the borderline statistical significance(HR:0.70,95%CI:0.60 to 0.79 vs 0.81,95%CI:0.75 to 0.87;respectively,P=0.06).Composite renal outcome was improved significantly higher in patients with no heart failure than in heart failure patients with preserved ejection fraction(HFpEF)(HR:0.60,95%CI:0.49 to 0.72 vs 0.94,95%CI:0.74 to 1.13;P=0.04).Acute renal injury occurred significantly less frequently in heart failure patients with reduced ejection fraction who received gliflozins than in HFpEF(HR:0.67,95%CI:51 to 0.82 vs 0.94,95%CI:0.82 to 1.06;P=0.01).Volume depletion was consistently increased in response to SGLT2i in all the subgroups.CONCLUSION Heart failure patients with lower LVEF and lower NYHA sub-classifications were found to be generally more likely to benefit from therapy with gliflozins.Further research are required to identify patient subgroups representing the highest benefits or adverse events in response to SGLT2i.

Are Solar Active Regions Born with Neutralized Currents?

Solar active regions(ARs)are formed by the emergence of current-carrying magnetic flux tubes from below the photosphere.Although for an isolated flux tube the direct and return currents flowing along the tube should balance with each other,it remains controversial whether such a neutralization of currents is also maintained during the emergence process.Here we present a systematic survey of the degrees of the current neutralization in a large sample of flux-emerging ARs which appeared on the solar disk around the central meridian from 2010 to 2022.The vector magnetograms taken by Helioseismic and Magnetic Imager onboard Solar Dynamic Observatory are employed to calculate the distributions of the vertical current density at the photosphere.Focusing on the main phase of flux emergence,i.e.,the phase in which the total unsigned magnetic flux is continuously increased,we statistically examined the ratios of direct to return currents in all the ARs.Such a large-sample statistical study suggests that most of the ARs were born with currents close to neutralization.The degree of current neutralization seems to be not affected by the active-region size,the active-region growing rate,and the total unsigned current.The only correlation of significance as found is that the stronger the magnetic field nonpotentiality is,the further the AR deviates from current neutrality,which supports previous event studies that eruption-productive ARs often have non-neutralized currents.

Effects of pressure relief holes on coal burst:Insights from true-triaxial unloading tests

Drilling pressure relief is one of the methods to reduce the risk of coal bursts in deep mines.However,the effect of the drill hole orientations has not been studied well enough to understand their impact on the burst failure mechanism.In this study,we investigated two designs of drill hole orientations.The first design includes drill holes located on the upper free face of the rectangular samples and labelled as upper hole(UH)and centre hole(CH)e the long axes of the drill holes are aligned with minor principal stress,s3,direction.The second design includes drill holes at the top(TH)and the side(SH)of the rectangular samples in which the long axes of the drill holes are aligned with the maximum,s1,and intermediate principal stress,s2,directions,respectively.The coal samples with the proposed drill hole orientations were subjected to the true-triaxial unloading coal burst tests.The results show that the drill holes reduce the risk of coal bursts.However,we found that the intensity of coal burst was significantly reduced with the SH-type,followed by the CH-types.We also observed that the coal burst intensity is reduced better for the CH,UH,TH,and SH-type drilling patterns.However,it was found that the orientations of drill holes have little influence on the failure mode(splitting).The acoustic emission(AE)activities for coal with drill holes noticeably decreased,especially for the UH and CH layouts.The drill holes reduced the upper limit of the AE entropy(chaos of microcracks generation).However,regarding reducing the coal burst risk,the TH and SH are less effective than UH and CH.

Rockburst proneness considering energy characteristics and sample shape effects

Accurate prediction of rockburst proneness is one of challenges for assessing the rockburst risk and selecting effective control measures.This study aims to assess rockburst proneness by considering the energy characteristics and qualitative information during rock failure.Several representative rock types in cylindrical and cuboidal sample shapes were tested under uniaxial compression conditions and the failure progress was detected by a high-speed camera.The far-field ejection mass ratio(FEMR)was determined considering the qualitative failure information of the rock samples.The peak-strength energy impact index and the residual elastic energy index were used to quantitatively evaluate the rockburst proneness of both cylindrical and cuboidal samples.Further,the performance of these two indices was analyzed by comparing their estimates with the FEMR.The results show that the accuracy of the residual elastic energy index is significantly higher than that of the peak-strength energy impact index.The residual elastic energy index and the FEMR are in good agreement for both cylindrical and cuboidal rock materials.This is because these two indices can essentially reflect the common energy release mechanism characterized by the mass,ejection velocity,and ejection distance of rock fragments.It suggests that both the FEMR and the residual elastic energy index can be used to accurately measure the rockburst proneness of cylindrical and cuboidal samples based on uniaxial compression test.

A Comprehensive Classification and Analysis of Geomagnetic Storms Over Solar Cycle 24

A geomagnetic storm is a global disturbance of Earth?s magnetosphere,occurring as a result of the interaction with magnetic plasma ejected from the Sun.Despite considerable research,a comprehensive classification of storms for a complete solar cycle has not yet been fully developed,as most previous studies have been limited to specific storm types.This study,therefore,attempted to present complete statistics for solar cycle 24,detailing the occurrence of geomagnetic storm events and classifying them by type of intensity(moderate,intense,and severe),type of complete interval(normal or complex),duration of the recovery phase(rapid or long),and the number of steps in the storm?s development.The analysis was applied to data from ground-based magnetometers,which measured the Dst index as provided by the World Data Center for Geomagnetism,Kyoto,Japan.This study identified 211 storm events,comprising moderate(177 events),intense(33 events),and severe(1 event)types.About 36%of ICMEs and 23%of CIRs are found to be geoeffective,which caused geomagnetic storms.Up to four-step development of geomagnetic storms was exhibited during the main phase for this solar cycle.Analysis showed the geomagnetic storms developed one or more steps in the main phase,which were probably related to the driver that triggered the geomagnetic storms.A case study was additionally conducted to observe the variations of the ionospheric disturbance dynamo(Ddyn)phenomenon that resulted from the geomagnetic storm event of 2015July 13.The attenuation of the Ddyn in the equatorial region was analyzed using the H component of geomagnetic field data from stations in the Asian sector(Malaysia and India).The variations in the Ddyn signatures were observed at both stations,with the TIR station(India)showing higher intensity than the LKW station(Malaysia).

Left bundle branch area pacing:A new era of cardiac resynchronization therapy?

The recent systematic review and meta-analysis provided a comprehensive focus on the current state of cardiac resynchronization therapy(CRT).The authors determined the feasibility of physiological left bundle branch area pacing(LBBAP)in patients indicated for CRT through a careful analysis of trials.They found that LBBAP was associated with significant reductions in QRS duration,New York Heart Association functional class,B-type natriuretic peptide levels,and pacing thresholds as well as improvements in echocardiographic parameters compared to biventricular pacing.

Kill two birds with one stone:Hapatologist’s approach to metabolic dysfunction-associated steatotic liver disease and heart failure

Heart failure(HF)is a major global public health concern,and one of the less commonly known risk factors for HF development is metabolic dysfunction-associated steatotic liver disease(MASLD),as they share a similar pathophysio-logical background.In this article,we evaluated a recently published review article by Arriola-Montenegro et al.This article briefly summarizes the common pathophysiology of HF and MASLD development and evaluates the available therapeutic options to treat both conditions.Clinical practice guidelines highlight the importance of initiating and titrating guideline-directed medication therapy(GDMT)for patients with HF with reduced ejection fraction.GDMT is comprised of the four pillars currently proposed in most clinical practice guidelines,namely angiotensin-converting enzyme inhibitors(ACEIs),angiotensin receptor blockers(ARBs),angiotensin receptor-neprilysin inhibitors,beta-blockers,mineralocor-ticoid receptor antagonists,and sodium-glucose co-transporter 2 inhibitors(SGLT-2i).Given the similarity of pathophysiology and risk factors,recent studies for GDMT regarding ACEIs,ARBs,mineralocorticoid receptor antagonists,and SGLT-2i have shown beneficial effects on MASLD.Nonetheless,other medications for both conditions and novel therapies require more robust data and well-designed clinical studies to demonstrate their efficacies in both conditions.

Sodium glucose cotransporter 2 inhibitors in the management of heart failure:Veni,Vidi,and Vici

Heart failure(HF)is a chronic disease associated with high morbidity and mortality rates.Renin-angiotensin-aldosterone system blockers(including angiotensin receptor/neprilysin inhibitors),beta-blockers,and mineralocorticoid receptor blockers remain the mainstay of pharmacotherapy for HF with reduced ejection fraction(HFrEF).However,despite the use of guideline-directed medical therapy,the mortality from HFrEF remains high.HF with preserved ejection fraction(HFpEF)comprises approximately half of the total incident HF cases;however,unlike HFrEF,there are no proven therapies for this condition.Sodium glucose cotransporter-2 inhibitors(SGLT-2is)represent a new class of pharmacological agents approved for diabetes mellitus(DM)that inhibit SGLT-2 receptors in the kidney.A serendipitous finding from seminal trials of SGLT-2is in DM was the significant improvement in renal and cardiovascular(CV)outcomes.More importantly,the improvement in HF hospitalization(HHF)in the CV outcomes trials of SGLT-2is was striking.Multiple mechanisms have been proposed for the pleiotropic effects of SGLT-2is beyond their glycemic control.However,as patients with HF were not included in any of these trials,it can be considered as a primary intervention.Subsequently,two landmark studies of SGLT-2is in patients with HFrEF,namely,an empagliflozin outcome trial in patients with chronic HF and a reduced ejection fraction(EMPEROR-Reduced)and dapagliflozin and prevention of adverse outcomes in HF(DAPA-HF),demonstrated significant improvement in HHF and CV mortality regardless of the presence of DM.These impressive results pitchforked these drugs as class I indications in patients with HFrEF across major guidelines.Thereafter,empagliflozin outcome trial in patients with chronic HF with preserved ejection fraction(EMPEROR-Preserved)and dapagliflozin evaluation to improve the lives of patients with preserved ejection fraction HF(DELIVER)trials successively confirmed that SGLT-2is also benefit patients with HFpEF with or without DM.These results represent a watershed as they constitute the first clinically meaningful therapy for HFpEF in the past three decades of evolution of HF management.Emerging positive data for the use of SGLT-2is in acute HF and post-myocardial infarction scenarios have strengthened the pivotal role of these agents in the realm of HF.In a short span of time,these classes of drugs have captivated the entire scenario of HF.

Epicardial adipose tissue in obesity with heart failure with preserved ejection fraction: Cardiovascular magnetic resonance biomarker study

BACKGROUND Obesity has become a serious public health issue,significantly elevating the risk of various complications.It is a well-established contributor to Heart failure with preserved ejection fraction(HFpEF).Evaluating HFpEF in obesity is crucial.Epicardial adipose tissue(EAT)has emerged as a valuable tool for validating prognostic biomarkers and guiding treatment targets.Hence,assessing EAT is of paramount importance.Cardiovascular magnetic resonance(CMR)imaging is acknowledged as the gold standard for analyzing cardiac function and mor-phology.We hope to use CMR to assess EAT as a bioimaging marker to evaluate HFpEF in obese patients.AIM To assess the diagnostic utility of CMR for evaluating heart failure with preserved ejection fraction[HFpEF;left ventricular(LV)ejection fraction≥50%]by measuring the epicardial adipose tissue(EAT)volumes and EAT mass in obese patients.METHODS Sixty-two obese patients were divided into two groups for a case-control study based on whether or not they had heart failure with HFpEF.The two groups were defined as HFpEF+and HFpEF-.LV geometry,global systolic function,EAT volumes and EAT mass of all subjects were obtained using cine magnetic resonance sequences.RESULTS Forty-five patients of HFpEF-group and seventeen patients of HFpEF+group were included.LV mass index(g/m2)of HFpEF+group was higher than HFpEF-group(P<0.05).In HFpEF+group,EAT volumes,EAT volume index,EAT mass,EAT mass index and the ratio of EAT/[left atrial(LA)left-right(LR)diameter]were higher compared to HFpEF-group(P<0.05).In multivariate analysis,Higher EAT/LA LR diameter ratio was associated with higher odds ratio of HFpEF.CONCLUSION EAT/LA LR diameter ratio is highly associated with HFpEF in obese patients.It is plausible that there may be utility in CMR for assessing obese patients for HFpEF using EAT/LA LR diameter ratio as a diagnostic biomarker.Further prospective studies,are needed to validate these proof-of-concept findings.

Dapagliflozin in heart failure and type 2 diabetes:Efficacy,cardiac and renal effects,safety

BACKGROUND Heart failure(HF),especially HF with reduced ejection fraction(HFrEF),presents complex challenges,particularly in the aging population where it often coexists with type 2 diabetes mellitus(T2DM).AIM To analyze the effect of dapagliflozin treatment on cardiac,renal function,and safety in patients with HFrEF combined with T2DM.METHODS Patients with T2DM complicated with HFrEF who underwent treatment in our hospital from February 2018 to March 2023 were retrospectively analyzed as the subjects of this study.The propensity score matching method was used,and a total of 102 eligible samples were scaled.The clinical efficacy of the two groups was evaluated at the end of the treatment,comparing the results of blood glucose,insulin,cardiac function,markers of myocardial injury,renal function indexes,and 6-min walk test(6MWT)before and after the treatment.We compared the occurrence of adverse effects on the treatment process of the two groups of patients.The incidence of adverse outcomes in patients within six months of treatment was counted.RESULTS The overall clinical efficacy rate of patients in the study group was significantly higher than that of patients in the control group(P=0.013).After treatment,the pancreatic beta-cell function index,left ventricular ejection fraction,and glomerular filtration rate of patients in the study group were significantly higher than control group(P<0.001),while their fasting plasma glucose,2-h postprandial glucose,glycosylated hemoglobin,insulin resistance index,left ventricular end-systolic diameter,left ventricular end-diastolic diameter,cardiac troponin I,creatine kinase-MB,N-terminal pro b-type natriuretic peptide,serum creatinine,and blood urea nitrogen were significantly lower than those of the control group.After treatment,patients in the study group had a significantly higher 6MWT than those in the control group(P<0.001).Hypoglycemic reaction(P=0.647),urinary tract infection(P=0.558),gastrointestinal adverse effect(P=0.307),respiratory disturbance(P=0.558),and angioedema(P=0.647)were not statistically different.There was no significant difference between the incidence of adverse outcomes between the two groups(P=0.250).CONCLUSION Dapagliflozin significantly enhances clinical efficacy,cardiac and renal function,and ambulatory capacity in patients with HFrEF and T2DM without an increased risk of adverse effects or outcomes.

Heart failure with preserved ejection fraction and the first law of thermodynamics

In heart failure with preserved ejection fraction,significant left ventricular diastolic abnormalities are present,despite a normal systolic ejection fraction.This article will consider whether this is consistent with the law of conservation of energy,also know as the first law of thermodynamics.

Dual-chamber pacing confers better myocardial performance and improves clinical outcomes compared to single-chamber pacing

The deleterious effects of long term right ventricular pacing are increasingly being recognized today.Current clinical practice favors the implantation of dual-chamber permanent pacemaker which maintains atrioventricular synchrony and is associated with better quality of life.However,despite the popular belief and common sense surrounding the superiority of dual-chamber pacing over single chamber pacing,the same has never been conclusively verified in clinical trials.Some observational evidence however,does exists which supports the improved cardiac hemodynamics,lower the rate of atrial fibrillation,heart failure and stroke in dual-chamber pacing compared to single-chamber pacing.In the index study by Haque et al,right ventricular pacing,particularly in ventricular paced,ven-tricular sensed,inhibited response and rate responsive pacemaker adversely im-pacted the left ventricular functions over 9-months compared to dual pacing,dual sensing,dual responsive and rate responsive pacemaker.Although there are key limitations of this study,these findings does support a growing body of evidence reinstating the superiority of dual chamber pacing compared to single chamber pacing.

Prognostic Role of Preoperative Tricuspid Annular Plane Systolic Excursion (TAPSE) in Mitral Valve Replacement (MVR) for Rheumatic Mitral Stenosis Patients

Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAPSE in patients with mitral valve replacement for rheumatic mitral stenosis patients is still under focused. Therefore, the objective of the study was to predict the outcome after MVR in rheumatic mitral stenosis patients in relation to preoperative TAPSE. This comparative cross-sectional study was conducted at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute. A total of 72 patients of rheumatic mitral stenosis patients who underwent mitral valve replacement were included in the study. They were divided into two groups: Group A and B. Group A included 36 patients with TAPSE 0.05) except for the preoperative TAPSE. Mean TAPSE of Group A was 13.17 (±1.40) and Group B was 18.61 (±1.57), the difference was statistically significant (p 0.05). Among the postoperative complications, including postoperative atrial fibrillation was higher in Group A (30.56%) than Group B (11.11%), mean ventilation time was higher in Group A (27.78%) than Group B (5.56%), length of intensive care was higher in Group A (33.33%) than Group B (11.12%), and hospital stay was higher in Group A (25.0%) than Group B (5.56%), (p < 0.05). Higher preoperative TASPE could be used as a prognostic tool for MVR in rheumatic mitral stenosis patients in our settings.

Health-related quality of life among congestive heart failure patients with preserved and reduced ejection fraction

Objective:To determine factors that affect the health-related quality of life(HRQOL)of congestive heart failure(CHF)patients with preserved and reduced ejection fraction.Methods:A cross-sectional study design was used for this study.The stratified random sampling was applied for each subgroup.HRQOL was measured with the Minnesota Living with Hear t Failure Questionnaire.The data were analyzed using chi-square,Spearman's correlation analysis,and independent t-test.Results:A number of 67 respondents participated in the recent study.The total mean scores of HRQOL were significantly different(P=0.001)between heart failure(HF)patients with reduced and preserved ejection fractions,41.07±7.54 and 54.97±4.36,respectively.It related with the physical(mean±standard deviation[SD]=10.4±2.14;t=-10.08,95%CI=-12.46 to-8.34;P-value=0.001)and psychological(mean±SD=3.5±0.5;t=-6.68,95%CI=-4.55 to-2.45;P-value=0.001)domain.Strong correlation was found between age(r=-0.898,P<0.05),NYHA functional classes(r=-0.858,P<0.01),duration of HF(r=-0.807,P<0.01),family support(r=0.927,P<0.01),and quality of life(Qo L).Conclusions:HRQOL in HF patients with reduced ejection fraction was higher than in those with preserved ejection fraction.Family suppor t is a fur ther determinant factor that has a positive correlation to the Qo L.

Observing the reconnection region in a transequatorial loop system

A vertical current sheet is a crucial element in many flare/coronal mass ejection （CME） models. For the first time, Liu et al. reported a vertical current sheet directly imaged during the flare rising phase with the EUV Imaging Telescope （EIT） onboard the Solar and Heliospheric Observatory （SOHO）. As a follow-up study, here we present the comprehensive analysis and detailed physical interpretation of the observation. The current sheet formed due to the gradual rise of a transequatorial loop system. As the loop legs approached each other, plasma flew at - 6 km s^-1 into a local area where a cusp-shaped flare loop subsequently formed and the current sheet was seen as a bright, collimated structure of global length （_〉 0.25 RQ） and macroscopic width （（5-10）× 10^3 km）, extending from 50 Mm above the flaring loop to the border of the EIT field of view （FOV）. The reconnection rate in terms of the Alfven Mach number is estimated to be only 0.005-0.009, albeit a halo CME was accelerated from - 400 km s- 1 to - 1300 km s- 1 within the coronagraph FOV. Drifting pulsating structures at metric frequencies were recorded during the impulsive phase, implying tearing of the current sheet in the high corona. A radio Type III burst occurred when the current sheet was clearly seen in EUV, indicative of accelerated electrons beam- ing upward from the upper tip of the current sheet. A cusp-shaped dimming region was observed to be located above the post-flare arcade during the decay phase in EIT; both the arcade and the dimming expanded with time. With the Coronal Diagnostic Spectrometer （CDS） aboard SOHO, a clear signature of chromospheric evaporation was seen during the decay phase, i.e., the cusp-shaped dimming region was associ- ated with plasma upflows detected with EUV hot emission lines, while the post-flare loop was associated with downflows detected with cold lines. This event provides a comprehensive view of the reconnection geometry and dynamics in the solar corona.

Effect of ETA receptor antagonist BQ-123 on cardiac function and endothelin system after coronary microembolization in rats

Objective To evaluate the effects of BQ-123 on cardiac function and ventricular remodelling after coronary microembolization (CME) in rats. Methods We created a rat model of CME by injecting a suspension of autogenic microthrombotic particles into left ventricle. Three days after the procedure, the 30 surviving rats were randomly divided into 3 groups, each consisted of 10 rats: sham-operation group(SO), CME model group(CM) and BQ-123 intervention group(BQ). Rats in the BQ group received BQ-123 (400μg/kg per day, intraperitoneally) for 4 weeks. Plasma and myocardial endothelin-1 (ET-1) were measured by radioimmunoassay. And serial echocardiography was performed to monitor alterations of left ventricular end-systolic and end-diastolic diameter (LVESD, LVEED), and left ventricular short-axis fraction shortening(LVFS) and ejection fraction (LVEF), and physiologicography to document the changes of left ventricular systolic pressure (LVSP) and end-diastolic pressure pressure(LVEDP), and left ventricular maximum positive and negative dp/dt (±LVdp/dtmax). Results Compared with sham-operated group, both LVEDD and LVESD were increased (P【0.01), whereas LVFS and LVEF were significantly decreased (P【0.01) in CME group; LVEDP was markedly increased, while LVSP and±LVdp/ dtmax markedly reduced in CME group (P【0.01); plasma and tissue ET-1 levels increased in CME group (P【0.01). BQ-123 intervention significantly decreased both the plasma and tissue ET-1 levels (P【0.01), and markedly increased LVFS and LVEF, with significant improvement of LVSP and±LVdp/ dtmax (P【0.01). Conclusions Treatment with BQ-123 prevents ventricular remodeling after CME due to suppression of the endothelin system.

Code generation and recognition using a modified ejection system in die-casting process

A code-generation and recognition technology that uses a modified ejection system in the diecasting process is presented.To achieve the highest level of quality management,the first requirement in the manufacturing process is to establish a product management system according to the specific product unit.Thus,a method to individually identify each product,such as a barcode or QR code,is required during the production process.Products manufactured in the die-casting process always have ejector pin(EP)marks.Herein,an ejection system was modified to generate a unique code using EP marks.This ejection system has two features:an EP with a modified head to show the direction of rotation,and a function to dependently rotate EPs(five or six EPs)with a constant angle.The EPs are numbered according to the rotation angle.Thus,the EP marks can be viewed as a five-or six-digit code.A program was also developed to individually identify the products by automatically detecting and reading the EPs using deep learning-based object detection and classification technology.

A Systematic Review Incorporating Meta-Analysis on the Effectiveness of Intravenous Immunoglobulin Versus Corticosteroids in the Treatment of Pediatric Myocarditis

Background:Concerns have been raised about the efficacy of intravenous immunoglobulin and corticosteroids in pediatric myocarditis;however,the relationship between the risk and efficacy of these two therapies in children with myocarditis varies.Methods:A systematic review on seventeen studies was conducted in July 2020,which included 1,960 subjects at the baseline,with 788 receiving intravenous immunoglobulin and 142 receiving corticosteroids.The mean difference(MD)or odds ratio(OR)with 95%confidence intervals(Cis)was calculated to assess the prognostic role of both treatments using dichotomous and continuous methods with random or fixed-effect models.Results:The use of intravenous immunoglobulin was significantly associated with a lower mortality rate or heart transplantation in children with myocarditis(OR,0.55;95%CI,0.40-0.77,^<0.001)compared with the control group.However,corticosteroids were not significantly associated with the same parameters(OR,0.72;95% CI,0.31-1.63,p=0.43).The use of intravenous immunoglobulin was not significantly related to improving left ventricular ejection in children with myocarditis(OR,2.30;95% CI,-9.65-14.25,p=0.71)and so were corticosteroids(MD,5.17;95% CI,-0.26-10.60,p=0.06).Conclusion:The use of intravenous immunoglobulin might have an independent risk relationship with a lower mortality rate or heart transplantation and is recommended in children with myocarditis to prevent complications.